Provider Demographics
NPI:1003098765
Name:MELISSA BALL
Entity Type:Organization
Organization Name:MELISSA BALL
Other - Org Name:PROFESSIONALS IN EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-877-6585
Mailing Address - Street 1:356 N MCWHORTER ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-2235
Mailing Address - Country:US
Mailing Address - Phone:606-877-6585
Mailing Address - Fax:606-877-9936
Practice Address - Street 1:356 N MCWHORTER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2235
Practice Address - Country:US
Practice Address - Phone:606-877-6585
Practice Address - Fax:606-877-9936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1337DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77900835Medicaid
KY4200770001Medicare NSC